The use of drotrecogin alfa (activated) in severe sepsis during acute pancreatitis - two case studies

Backround: Twenty-five percent of patients with diagnosed acute pancreatitis (AP) present a severe form of it. One of the most widespread complications of such a form is severe sepsis or septic shock, in which mortality can reach 80%. A complication of this state is multiple organ failure, which requires multi-directional treatment in an intensive care unit (ICU). Among the standard therapies are: control of the source of infection, supportive treatment of failed organ function, and others (e.g. dietary therapy, pain management, and physiotherapy). It is also now possible to use recombinant human activated protein C [drotrecogin alfa (activated); Xigris, Eli Lilly, USA] in the treatment of severe sepsis. Case Report: In this study, the cases of two patients in whom severe sepsis was found during the course of acute pancreatitis are presented. In both cases it was established clinically (by laparotomy) and bacteriologically that necrosis-altered fragments of the pancreas were the sources of infection. Conclusions: Both the cases presented indicate that drotrecogin alfa (activated) interrupts the developmental cascade of severe sepsis. Proofs of the efficacy of the treatment were improvements in the functions of organs previously insufficient during the course of sepsis. The rapid elimination of the drug allowed planning therapy strategies (the possibility of conducting surgical operations and smaller therapeutic interventions) without the risk of increased bleeding. The decision to use Xigris in severe sepsis during AP should always include consideration of die risk of bleeding in connection with the local status within the pancreas.